Provider Demographics
NPI:1700884285
Name:JOHNSON, CAROL ANN (AUD, F-AAA)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 MOUNT MORIAH RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-1632
Mailing Address - Country:US
Mailing Address - Phone:770-505-7872
Mailing Address - Fax:770-425-4330
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:770-343-8675
Practice Address - Fax:770-343-8126
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD001881231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64BCBMXMedicare ID - Type Unspecified
P48388Medicare UPIN